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Drinking patterns change with age.


VANCOUVER, B.C. -- Certain patterns of alcohol consumption appear detrimental to older adults" cognitive health, according to a pair of longitudinal cohort studies..

In a study of older women, moderate drinking at a mean age of 81 years and initiation of drinking after a mean age of 68 years increased the odds of cognitive impairment. In a study of older men and women, those consuming large amounts of alcohol in a single sitting, so-called binge drinking, were more likely to be in the top decile of cognitive decline over time.

These new findings call into question what constitutes risky drinking in older adults and conventional practices of risk assessment, investigators reported at the conference.

Drinking Patterns in Older Women

A team led by Tina D. Hoang, M.S.P.H., of the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, analyzed data from 1,306 community-dwelling, dementia-free women aged 65 years or older from the Study of Osteoporotic Fractures.


Research has suggested a J-shaped association between alcohol intake and dementia risk, whereby moderate alcohol intake is protective, she noted. However, "in most of the studies for dementia that are prospective, the follow-up time is between 5 and 6 years, and in terms of assessment of alcohol use, it's primarily at baseline, focusing on midlife and early latelife stages of alcohol use. Few studies have really looked at patterns of use or changes in use over time."

The women studied had serial assessments of drinking over time and a cognitive evaluation at year 20, when they were, on average, 88 years old. At that time, 41% had cognitive impairment.

Adjusted analyses showed that women who, at baseline, reported drinking more in the past had 1.3-fold higher odds of developing cognitive impairment relative to their counterparts who had not changed their drinking habits up to that point.

With regard to current drinking, light and moderate drinkers had nonsignificantly reduced odds of cognitive impairment relative to nondrinkers at mean ages of 68 and 75 years. But moderate drinkers at a mean age of 81 years had 1.6-fold higher odds of cognitive impairment as same-aged nondrinkers.

Finally, with respect to patterns of use over the first 16 years of follow-up, women who started drinking during this time had threefold higher odds of cognitive impairment than did their counterparts who were consistently nondrinkers.

"It may be that alcohol use has different effects throughout the life course," Ms. Hoang commented. "As adults age, they may be taking more medications, and it may be ... there are interactions of alcohol with those medications."

Alternatively, there may be interactions with apolipoprotein e (APOE) genotype, not assessed in the study, or the brains of the oldest old adults may be more vulnerable to the effects of alcohol. Finally, changing patterns of use over time may just be indicators of events such as illness, which themselves might increase risk of cognitive impairment.

"The American Geriatric Society recommends screening older adults for at-risk drinking, defined as drinking greater than one drink per day for older adults," Ms. Hoang noted. "We think that our findings suggest that it may be important to not just screen older adults for at-risk drinking or alcohol abuse, but also to look at history of past use and changes in use that may be associated with cognitive impairment.

"We think our findings also indicate that moderate use may not be protective in the oldest old, and it just shows the need for more life-course research so we can understand the effects of moderate alcohol use at different stages of life," she concluded.

Binge Drinking in Seniors

A team led by lain A. Lang, Ph.D., of Peninsula College of Medicine and Dentistry in Exeter, Devon, England, studied binge drinking among 5,075 U.S. community-dwelling men and women aged 65 years or older from the Health and Retirement Study.

Research on alcohol consumption and cognitive decline has generally not included many heavy drinkers, he pointed out. "I think this is because of what may be a recurring problem in studies of this type, that people who are heavy drinkers either don't participate in cohort studies or else misrepresent their drinking levels."

Cognitive well-being was assessed in the older adults over an 8-year period with the Telephone Interview for Cognitive Status (TICS) total score and memory component.

Results showed that, at baseline, 4.3% of the participants binge drank (consumed at least four drinks on a single occasion) at least once monthly, and 2% did so at least twice monthly.


In multivariate analyses, the older adults binge drinking at least once monthly had 1.62-fold higher odds of being in the top 10% of cognitive decline, and those binge drinking at least twice monthly had 2.47-fold higher odds. Additionally, the latter had 2.49fold higher odds of being in the top 10% of memory decline.

"The findings are fairly robust, and I think that the main implication is that older adults should be aware that heavy episodic drinking is associated with an increased risk of cognitive decline," Dr. Lang said. The J-shaped risk curve whereby moderate drinking is protective may well exist, but previous studies have overlooked the pattern of drinking that people engage in, he said.

He proposed that there may well be a big difference between consuming seven drinks on one occasion, versus a single drink a day for seven days--even though people are often simply asked how much they drink in a week.

"'Older adults and their care providers and others should be aware that these drinking patterns are important," he said, adding that physicians who are concerned about their patients' alcohol drinking "ought to be aware that it's the pattern of drinking and not just the total amount that's of consequence here."

Additionally, "I think it's quite important that we don't consider binge drinking simply to be a problem of younger adults, which is often what we see," maintained Dr. Lang. "A lot of the media attention and research attention is focused on adolescents, college students, and younger adults in whom binge drinking is more common. We need to be aware that binge drinking goes on and is a health problem in older adults as well."

Ms. Hoang disclosed no relevant conflicts of interest. Dr. Lang disclosed no relevant conflicts of interest.
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Title Annotation:METAL HEALTH
Author:London, Susan
Publication:Family Practice News
Article Type:Clinical report
Date:Sep 1, 2012
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